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97-103555
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H it it N o d H 1 ti II{ (A) F3 W \r)° H H 11 n fl F1 ` - !1 N +4 A n 11 n F H w A N O. n n n O If n II n n CO Cat O 017 n II fl H O 0 0 0 11 II II OD 11 n 11 It J 11 II H 0 RECEIV • • BUILDING DrvisroN arror 33530 First Way South � 2 SEP 2 997 Federal Way,WA 98003 � `� � (253)661-4000 Gal OF FE G DEPT AY Fax(253)661-4129 BUILDING APPLICATION FOR BUILDING PERMIT • PLEASE PRINT APPLICATION# PJ L D (7— D 5 79- ::>::.>.::<:::<:;:;;::::::>:::::::::::::<::»1111:11::>:>:: Address s r ^ �s4 Tenant(if known) Lot# / J Assessor's Tax# /z2103 9PS7 67 Building Owner's Name /34) W J !)5��6 Address C 1166 s' -' l City Ke lir I State 61:7 Zip 'Phone dzY/ Nature of Work $,E 1 A/Z1C Name( M L) 1)r h))//5/ Address ./ z. / ,(by) S. ' ` �? City K.t t9 / lO / / - State /,ve"9 Zip T Y Z Contact Pmson Day Phone C y/ a G a Other Phone Fax • Company Name Q ,/_ `3 'Do/3 t Lr f7�M ( c Address Fz 3z , �f! C`� 7 S City '-A�f y) State IL).'l Zip Contact Person i Phone Fax © zL ZOi Contractor's #(card must be presented) • Expiration Date Verified 0 Yes 0 No Name �l M Address City State Zip Contact Person Phone Fax LEGAL DESCRIPTION Please Complete Reverse Side sti n Use P osed Use 9 Permit includes: ❑ Building ❑ Plumbing ❑ Mechanical ❑ Other Type of Work: ❑ Residential ❑ New ❑ Remodel ❑ Number of Units ❑ Deck ❑ Commercial ❑ Addition ❑ Garage ❑ Shed ❑ Other Enter 1st Floor'Z V sq ft 2nd Floor sq ft 3rd Floor sq ft Existing Floor Area sq ft Area Basement s. ft Decks s. ft Garage s. ft Pro.osed Total Area s. ft Water Availability ❑ Sewer Availability ❑ On-Site Septic System Availability ❑ Project Valuation $ Zoning I Lot Size Existing Bldg Valuation _$ / g20 Name Address City _State I Zip Contractor Name Address City State Zip Contact Phone Fax License # Expiration Date Verified ❑ Yes ❑ No iiiiiiiikaiiiiiiikaidiiIIIIIIIIIIIIIIIIII Contractor Name Address City State Zip Contact Phone Fax License # Expiration Date Verified ❑ Yes ❑ No Water Closets Sinks Urinals Lawn Sprinklers Bathtubs Dish Washers Drinking Fountains Other Showers Electric Water Heaters Sumps Lavatories Washing Machine _Drains Total`Flxttxre.! ouitt Iiiiiiragailliiiiiiiiiiiiiilliiiiiiiiiii MECHANICAL EVALUATION ONLY Fuel Type (electric/other) Gas Dryer Air Handling < = 10,000 CFM 15-30 Tons Length of Gas Piping Range Air Handling > = 10,000 CFM 30-50 Tons Furn <100K BTUs Gas Log Unit Heater 50+ Tons Furn >100 BTUs Fans Miscellaneous Fuel Tanks Gas Hwt Hood Boilers Above Ground Cony Burner Duct Work 0-3 Tons Underground ...........................................................•........................................ ................. BBQ's Wood Stoves 3-15 Tons atal tltt C•....••; :::::;:>;..........;':;[;:: DISCLAIMER:I certify under penalty of perjury that the information furnished by me is true and correct to the best of my knowledge,and further,that I am authorized by the owner of the above premises to perform the work for which permit application is made.I further agree to save harmless the City of Federal Way as to any claim(including costs,expenses,and attorneys'fees incurred in investigation and defense of such claim),which may be made by any person,including the undersigned,and filed against the City of Federal Way,but only where such claim arises out of the reliance of the ci ,including its officers and employees,upon the accuracy of the information supplied to the city as a part of this application. Owner/Agent: 627P2 Date: BUILDING.AID REVISED 8128/97 -ID 7J 71 m om T m M �� T➢ s00 y o� ice _ o ° '" r ° acs °� 7°go , b % uz-,�-4 n'-I n 7D 4 r- z °- Vrt ...- % � 4,3 ci)m cn _ mmm r"U)cn 0 r*. t ...V Q �x5 cmnF �, �^ m� b ° 3 0m >< n) C Ti- v I_4 z'. . P o D N =a c l / )1 7 I- M . 'V 1 f.Z .. 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